宫腔镜诊治子宫肌瘤对预防不孕症的可行性及临床意义分析

Analysis on the feasibility and clinical significance of hysteroscope in diagnosis and treatment of uterine fibroids in prevention of infertility

目的探讨宫腔镜诊治子宫肌瘤对预防不孕症的可行性及临床意义。方法选取2018年2月—2019年2月宁波市妇女儿童医院收治的84例子宫肌瘤患者为研究对象,依据手术指征分为A(经阴道超声组,39例)、B(子宫输卵管造影组,36例)及C(宫腔镜检查,9例)3组,应用随机数字法随机分为观察组和对照组,对照组进行常规开腹手术,观察组进行宫腔镜子宫肌瘤电切术。结果A组与B组患者宫腔镜诊断阳性率比较,差异无统计学意义(χ^(2)=1.638,P>0.05);两组患者宫腔镜诊断阳性率均明显高于C组,差异均有统计学意义(χ^(2)=5.671、4.684,均P<0.05);观察组患者治疗有效率(97.6%)、妊娠率(95.2%)均高于对照组(83.3%、76.2%),流产率(2.4%)低于对照组(16.7%),差异均有统计学意义(χ^(2)=5.394、5.138及5.076,均P<0.05);观察组患者住院时间[(3.1±1.3)d]、手术时间[(57.2±19.0)min]、肛门排气时间[(10.7±2.0)h]及出血量[(30.1±3.5)ml]均低于对照组[(6.2±1.9)d、(64.2±10.5)min、(18.6±3.8)h及(36.3±4.1)ml],差异均有统计学意义(t=1.294、10.391、12.125及11.935,均P<0.05)。结论对子宫肌瘤患者进行宫腔镜诊治,诊断阳性率高。与传统开腹手术比较,宫腔镜子宫肌瘤电切术具有更高治疗有效率,可缩短住院、手术及肛门排气时间,减少出血量,改善妊娠结局,对临床症状改善具有非常重要作用,值得推广和应用。

Objective To explore the feasibility and clinical significance of hysteroscope in diagnosis and treatment of uterine fibroids in prevention of infertility.Methods From February 2018 to February 2019,84 patients with uterine fibroids treated in Ningbo Women and Children’s Hospital were selected and divided into A group(transvaginal ultrasound group,39 cases),B group(uterosalpingography group,36 cases),and C group(hysteroscopic examination group,9 cases)according to surgical indications,then the patients were divided into observation group and control group according to random number table,the patients in control group were treated with routine laparotomy,and the patients in observation group were treated with hysteroscopic hysteromyoma resection.Results There was no statistically significant difference in the positive rate of hysteroscopy between A group and B group(χ^(2)=1.638,P>0.05).The positive rates of hysteroscopy in A group and B group were statistically significantly higher than that in C group(χ^(2)=5.671,4.684,P<0.05).The effective rate and pregnancy rate in observation group were 97.6%and 95.2%,respectively,which were statistically significantly higher than those in control group(83.3%,76.2%),the abortion rate in observation group was 2.4%,which was statistically significantly lower than that in control group(16.7%)(χ^(2)=5.394,5.138,5.076,P<0.05).The hospitalization time,operation time,anal exhaust time,and blood loss in observation group were(3.1±1.3)days,(57.2±19.0)minutes,(10.7±2.0)hours,and(30.1±3.5)ml,respectively,which were statistically significantly lower than those in control group[(6.2±1.9)days,(64.2±10.5)minutes,(18.6±3.8)hours,and(36.3±4.1)ml],the differences were statistically significant(t=1.294,10.391,12.125,11.935,all P<0.05).Conclusion Hysteroscopic diagnosis and treatment of uterine fibroids has a high positive rate.Compared with traditional laparotomy,hysteroscopic hysteromyoma electrotomy has a higher therapeutic efficiency,which can shorten hospitalization,operation time and anal exhaust time,reduce blood loss,improve pregnancy outcome,and play a very important role in improving clinical symptoms.Therefore,hysteroscopy diagnosis and treatment is worthy of further promotion and application.